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New Documentary Explores Challenge to Public Hospitals in Serving Uninsured

Jeffrey Brown previews “The Waiting Room,” a documentary that goes behind the scenes of an Oakland hospital’s fight to survive in the recession and juggle patient needs that range from basic to life-threatening. Director Peter Nicks set out to profile a community but ended up with a larger story about health care in the U.S.

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    Finally tonight: A new documentary chronicles what life is like for patients and doctors at a busy, safety net hospital in California.

    And again to Jeff, who recorded this conversation recently.


    The daily life of a large, under-resourced, urban public hospital, a new documentary offers no experts and no statistics, just a rare fly-on-the-wall look inside an overwhelmed and at times overwhelming system and its impact on patients and staff.

    "The Waiting Room" — and there is indeed a lot of waiting going on — is set in Highland Hospital in Oakland, California. The film has been screening at film festivals around the country and has already won several awards. It will get a national theater release in the fall, and will air on PBS' "Independent Lens" next year.

    It's director, Pete Nicks, joins me now.

    Welcome to you.

    PETER NICKS, Director, "The Waiting Room": Hi.


    This started out with a personal connection, right? Your wife worked at the hospital. But what did it become for you? What were you after?


    Well, I was really inspired to make the film to a large degree because of these stories that she would come home with.

    We had just finished graduate school and she went to work at Highland Hospital. I had just finished film school. And they were stories about the resilience of not just the patient population, but the caregivers that were also charged with caring for this community of largely uninsured patients, and also their struggle on a day-to-day basis.

    And so, I wanted to try to capture that in some way in a film and share it with the country.


    I guess, from television hit shows, we're familiar with the emergency room and the traumas that come in. And there is that in this film.

    But this is more about people coming for daily care, daily needs, people who are uninsured and don't have doctors of their own.


    When I began the film, what I wanted to do was mainly tell the story of a community and an institution largely disconnected from the conversation around health care reform.

    But documentaries take a long time to make. And in intervening years, I think the noise in the conversation and the debate around the health care crisis in this country really started to get louder and louder. And the film — at that point, I began to look at the waiting room as a place where people were coming largely for lower-acuity issues, and that the waiting room was being used for things other than emergencies.

    And so we began to focus on trying to show and tell the story of that waiting room that was sort of torn between these two roles of providing emergency care and also primary care for a large community.


    All right, I want to show a little clip. It's actually two short scenes, right, one out in the waiting room and one behind the scenes. So we see both patients and doctors.

    Let's take a look at that.



  • MAN:

    What, do they got to wait for a bed or something? Or — what is the holdup? They can take me back there, clean the (INAUDIBLE) see what the hell the problem is. You know what I'm saying? X-rays or something. And do what they got to do. That bullet has got to be moving, gots to be. God, take this thing away from me, please.

  • MAN:

    We don't have any (INAUDIBLE) beds. We have one SDU bed that is going to 10 pending a discharge.

  • MAN:

    Oh, this guy is going to be able to go. Yes, this guy just needs to scan his aorta really quick with ultrasound and make sure he doesn't have a AAA, and then he can go.


  • WOMAN:

    All I need to do. So, three is going into the hallway and your DKA is going to seven and seven is going to three?

  • MAN:

    Yes. And I have got two people I will discharge for you soon.

  • WOMAN:

    All right.

  • MAN:

    And I have got a hall one patient I can also discharge with shoulder pain. I need to reassess real quick. But he got lost in the shuffle.


    So, tell me about — the man we're seeing in the waiting room has actually had a gunshot wound, right, that he was trying to get taken care of.

    And then the doctors are the people trying to figure out where they are putting people like him.


    Right, right.

    I think the waiting room sees a whole range of people, from people who come in with very acute, urgent needs, to people who are coming in for, you know, pains or just basic, basic things.

    With this character, you know, one of — a public health issue in this country happens to be violence. And in communities like Oakland, there is a large number of people who are shot on a daily basis. And when we were there, this was a very regular occurrence.

    And here's a guy who was shot several days before, who is coming back because, you know, the wound is bothering him. And he has to wait because the hospital's dealing with a triple shooting. And so the irony of that situation, you know, wasn't lost on us in the edit room. And those were some of the juxtapositions that we tried to make a statement with, to show the different ways that the public health care system is placed under tremendous strain that's beyond their control.


    And then you see these doctors who are just almost juggling rooms and beds.


    And that's the sort of the behind the scenes .

    With documentary, what you try to do is take the audience into places where they ordinarily can't go. And one of the things that we, that I was really amazed with early on was how clever the staff has to be to try to manage the flow of patients. And if they don't make the right decisions, things start to back up.

    It's almost like — it's almost like a video game, you know, where you have to, you know, place patients, move patients, keep the flow going. And if you don't, it stacks up, and then the waiting room backs up, and people get frustrated, they get angry. And then you have to deal with that. And it just keeps spinning more and more out of control.


    I saw one review that — saying that advocates on all sides of the health care debate could sort of view this and sort of feed their own views into it.

    You said you started this sort of before all that heated up, but now you do see it playing. It's going to get out into a national audience. It's going to get on PBS, as we said. So it's going to become part of that, I guess, part of that debate.


    It is.

    And one of the things that I felt was vital — and, you know, at this moment in time, as we're debating the health care crisis on a very high level, where policies are being made that are going to affect individuals and communities for possibly generations, that people's voices, particularly in public hospitals like this one and hospitals around the country, were not being heard and were not being represented in that conversation.

    And we felt, A., it was important to bring them into that conversation, and, B., to do it in way that was as non-political as possible. Now, every filmmaker brings some kind of, you know, agenda to the table. We all have our personal beliefs. And, certainly, I do.

    But, primary, that is that we need a better, more equitable health care system, and that here's this community of people who are trying to navigate the system. But we wanted to do it in way that just allowed their voices to come through naturally, without us as filmmakers making a sharp statement on one side or the other, and to let the audience make up their own minds what the significance of this experience of this one community was.


    OK. The film is called "The Waiting Room."

    Pete Nicks, thanks so much.


    Thank you.

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